A path is needed and a guide is needed to identify interstitial lung diseases (ILD) as soon as possible, complications that affect the lungs in patients with autoimmune rheumatological diseases and which are still poorly understood. In other words, a protocol is needed to make rheumatologists, pulmonologists, radiologists, internists and other specialists dialogue: a direction shared also by patient associations. How to make it happen? Investing in training and in the creation of a network of centers of reference, the experts respond from the webinar “The impact of multidisciplinary collaboration in the management of ILD in patients with autoimmune rheumatological diseases: the RETE ILD project”, organized by ISHEO with the unconditional contribution by Boehringer Ingelheim Italia SpA
Pulmonary interstitial diseases
“Pulmonary problems are present in various autoimmune rheumatological diseases, albeit to varying degrees and with different clinical manifestations”, explains Gian Domenico Sebastiani, Director of the Rheumatology Complex Operating Unit of the San Camillo-Forlanini Hospital in Rome. There is therefore the need for a multidisciplinary collaboration between rheumatologist and pulmonologist, to deepen and better define some characteristics relating to the patient’s situation and to set up the therapeutic plan together. The collaboration also concerns the radiologist who is an integral part of the patient’s analysis and other specialists involved according to the prevailing clinical manifestations, such as the cardiologist, the nephrologist, the internist, the neurologist, the gastroenterologist, the dermatologist and so on “.
Team multidisciplinari
Creating efficient multidisciplinary teams means improving the accuracy and timing of diagnosis. “The awareness on ILD and training must acquire a fundamental role”, underlines Carlo Vancheri, Full Professor of Diseases of the Respiratory System at the University of Catania: “The knowledge and awareness of these issues, unfortunately, is not widespread in a homogeneous manner throughout Italy at the level of both public opinion and health professionals. Increasing the knowledge of these pathologies is instead the real key, the best tool to arrive at an early diagnosis, and it is an aspect closely linked to training. The latter is essential for an improvement in the quality and accuracy of the work of all the specialists involved in the clinical management process of these diseases ”.
High resolution chest CT scan
Another important aspect to consider for an early identification of pulmonary complications in rheumatological patients concerns the use of radiological instruments. “Lung diseases associated with autoimmune rheumatological diseases are among the most complex to detect and analyze at the imaging level, and high resolution chest CT scan (HRCT) is always the best tool for the early identification of ILDs,” he adds. Nicola Sverzellati, Director of the Operational Unit of Radiological Sciences of the University of Parma: “Correct execution, however, is essential in order to obtain a report that really allows us to interpret the patient’s condition, and this aspect can only be improved through a adequate training of radiological specialists “.
Sistemi Hub&spoke
The entrusting of a patient to a reference center that knows how to manage the path from a clinical and radiological point of view is the major criticality linked to the problem of delay in an ILD diagnosis. “It is advisable to create a virtuous path as soon as possible, implementing the network operation of the Hub & Spoke systems – concludes Antonino Mazzone, Director of the Medical Area, Chronicity and Continuity of Care at Asst Ovest Milanese in Legnano – and formally identifying according to defined criteria the Hub centers for the management, management and treatment of ILD in patients with autoimmune rheumatological diseases “.